Picture of Chrysalis Butterfly

Worker Application Form

Please fill out the following online application below to register to work on an upcoming Heart of Georgia Chrysalis weekend. You should receive confirmation from the Lay Director if you are selected to work. If you have any questions, contact the Registrar at chrysalisregistrar@live.com.

NEW! All workers must have a background check performed every year to continue working on Heart of Georgia Chrysalis walks. Please download the Background Check Information packet for more information.

Download the Background Check Information Packet


Worker Registration Application

Worker Information

Name *

First

Last
Mailing Address *
Street Address
City
State
Postal / Zip Code
Home Phone

-
- Please include at least one phone number.
Cell Phone

-
-
Other Phone

-
-
Email *
Date of Birth

/
/
Sex *
 Male 
 Female 

Your Chrysalis Walk

What Chrysalis or Emmaus Walk did you first attend? *  
   
Walk Number  
Can't remember? Click here to view previous Chrysalis walks. (Opens in new window or tab)

Working Walk

You cannot work an opposite gender Chrysalis unless you are 25 or married.
What walk would you like to work on? *
First Choice
 
   
What walk would you like to work on?
Second Choice
 
   
Check any of the following areas you have ALREADY served in.
Lay Director 
Spiritual Director 
Assistant Lay Director 
Assistant Spiritual Director 
Table Leader 
Assistant Table Leader 
Youth Assistant Lay Director 
Worship 
Music 
Angel 
Agape 
Kitchen Head 
Kitchen 
72 Hour Prayer Vigil 
Other 
None 
   
Check any of the following areas you would LIKE TO SERVE.
Lay Director 
Spiritual Director 
Assistant Lay Director 
Assistant Spiritual Director 
Table Leader 
Assistant Table Leader 
Youth Assistant Lay Director 
Worship 
 Music 
Angel 
Agape 
Kitchen Head 
Kitchen 
72 Hour Prayer Vigil 
Steering Committee 
Other 
   
If you have given a talk, please check the ones you have given.
 Ideals *
 God Loves You
 Faith
 God Designed You *
 Prodigal
 Communication through Prayer
 Growth through Study
 God's Gifts to You *
 Marriage
 God Empowers You *
 Christian Action
 Single Life
 God Sustains You *
 Priesthood of All Believers
 Next Steps
              * Clergy Only
   
If you would like to give a talk, please check the ones you are most interested in.
 Ideals *
 God Loves You
 Faith
 God Designed You *
 Prodigal
 Communication through Prayer 
 Growth through Study
 God's Gifts to You *
 Marriage
God Empowers You *
 Christian Action
 Single Life
God Sustains You *
 Priesthood of All Believers
 Next Steps
              * Clergy Only
   
If you would like to serve on the Steering Committee, what area(s) interest you?  
Anything else you would like to add to the application?  

Payment & Misc Information

Payment *
 I understand the registration fee to work a Chrysalis weekend is $110.00. 
The registration fee is due at check-in prior to the Chrysalis weekend Sendoff. Checks can be made out to Heart of Georgia Chrysalis.

You should receive confirmation from the Lay Director if you are selected to work on their Chrysalis walk.

NEW! All workers must have a background check performed every year to continue working on Heart of Georgia Chrysalis walks. Please download the Background Check Information Packet for more information.